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Advances in Therapeutic Endoscopic Treatment of Common Bile Duct Stones

Abstract. Advances in cannulation techniques and instruments have helped in difficult bile duct cannulation and thus stone extraction. For small common bile duct (CBD) stones, endoscopic papillary balloon dilatation has been proposed as an alternative to endoscopic papillotomy (EPT). The technique must undergo further evaluation before recommending its routine use. For most patients with bile duct stones, EPT remains the method of choice. Out of 8204 patients treated in three surgical endoscopy centers (Chile, Germany, and India), 86% to 91% of all CBD stones could be extracted subsequently after EPT using a Dormia basket; 4% to 7% required mechanical lithotripsy (ML) before removal and 3% to 10% of the patients needed other sophisticated techniques, such as electrohydraulic lithotripsy (EHL), laser-induced shock-wave lithotripsy (LISL), or extracorporeal shock-wave lithotripsy (ESWL). The local expertise and availability of equipment determines the choice of method used. In general, EHL or LISL is used for impacted CBD stones including stones in Mirizzi syndrome refractory to ML. ESWL is best suited for intrahepatic stones. Permanent stenting can be offered to poor risk patients instead of extensive procedures to clear the bile duct. Using currently available nonsurgical techniques, fewer than 1% of all patients with bile duct stones still require surgical intervention.

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Explore related subjectsDiscover the latest articles and news from researchers in related subjects, suggested using machine learning. Author information Authors and Affiliations

  1. Department of Endoscopic Surgery, University Hospital Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany, , , , , , DE

    Uwe Seitz, Sabine Bohnacker & Nib Soehendra

  2. S.M.S. Endoscopy Centre, Bhatia General Hospital, Tardeo Road, Mumbay 400007, India, , , , , , IN

    Amol Bapaye & Amit Maydeo

  3. Clinica Santa Maria, Avenida Santa Maria 0410, Casilla 4259, Santiago, Chile, , , , , , CL

    Claudio Navarrete

Authors
  1. Uwe Seitz
  2. Amol Bapaye
  3. Sabine Bohnacker
  4. Claudio Navarrete
  5. Amit Maydeo
  6. Nib Soehendra
About this article Cite this article

Seitz, U., Bapaye, A., Bohnacker, S. et al. Advances in Therapeutic Endoscopic Treatment of Common Bile Duct Stones. World J. Surg. 22, 1133–1144 (1998). https://doi.org/10.1007/s002689900532

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